ESPN 51th Annual Meeting

ESPN 2018


 
Multiple thrombosis in the newborn — 7 years of follow-up
EVGENIYA TOLSTOVA 1 KHADIZHA EMIROVA 1 ALEXANDRA DEMIDOVA 1 SOFIYA MSTISLAVSKAYA 1 OLGA ORLOVA 1 ALEXANDR MUZUROV 2 TATIANA ABASEEVA 3 GALINA GENERALOVA 4

1- MOSCOW STATE UNIVERSITY OF MEDICINE AND DENTISTRY NAMED AFTER A.I. EVDOKIMOV
2- RUSSIAN MEDICAL ACADEMY OF POSTGRADUATE EDUCATION
3- M.F. VLADIMIRSKY MOSCOW REGIONAL RESEARCH AND CLINICAL INSTITUTE (MONIKI)
4- ST. VLADIMIR CHILDRENS MOSCOW CLINICAL HOSPITAL
 
Introduction:

Children who have undergone bilateral thrombosis of renal vessels in the newborn period need long-term follow-up due to the high risk of kidney function decline.

Material and methods:

To present a clinical case of a patient with multiple thrombosis thrombosis in the neonatal period.

Results:

Patient K. (7 years old) is observed in the hemodialysis unit with a diagnosis: Chronic kidney disease stage II, nephrosclerosis, arterial hypertension. The child from 2nd physiological childbirth. Amniotic fluid was green. His weight at birth was 3240g. 3.5 hours after birth he was transferred to the ICU with gross hematuria, pulmonary and gastrointestinal bleeding. Identified oligoanuria, uremia, coagulopathy (low level of at III (38%), increased D-dimer (14240нг/ml), decreased level of protein C (67%) and S (71%). Bilateral thrombosis of renal veins, thrombosis of the vena cava inferior, the left branch of the portal vein, hemorrhage in the adrenal glands on both sides, hemorrhage in the right temporal were diagnosed in ultrasound. After transfusions of FFP, antithrombin 3, heparin, acute renal damage were reduced to 7 day. A molecular genetic study revealed multiple polymorphisms of the hemostatic system. Currently, GFR according to Schwartz reduced to 67 ml/min/1,73m2. According to ultrasound, there are signs of nephrosclerosis on the right, vicar hypertrophy of the left kidney. He constantly receives ACE inhibitors with nephroprotective and antihypertensive purposes.

Conclusions:

Deficiency of natural anticoagulants in the neonatal period on the background of genetic thrombophilia led to pathological thrombosis in the patient who underwent intrauterine hypoxia. Substitution therapy with antithrombin 3 in a child with common thrombosis due to deficiency of natural anticoagulants is first-line therapy. After thrombosis, long-term observation of specialists is necessary due to the risk of repeated thrombosis and progression of organ dysfunction.